Thyroid cancer arises from the tissues of the thyroid gland. This gland is located in the front of the neck and regulates hormones in the body. There are five main types of thyroid cancers. Papillary, follicular and hurthle cell carcinomas are called differentiated thyroid cancers. Other types are medullary carcinoma and anaplastic thyroid cancers.
Symptoms:
A most common symptom of thyroid cancer is a nodule in the front of the neck. Sometimes the patient presents with an enlarged neck node. Symptoms which can represent an advanced stage disease are pain, change in voice or breathing difficulty.
Diagnosis:
For a suspected or known thyroid nodule USG of the neck is the first investigation to be done followed by a US-guided FNAC. Further evaluation with CT or MRI scan is done depending on the results of initial tests to assess the operability, especially for locally advanced disease. Additional testing, which includes serum calcium, calcitonin, CEA and germline RET mutation is recommended for medullary thyroid cancers.
Treatment:
Surgical removal of part of the gland (lobectomy) or whole gland (total thyroidectomy) with the removal of neck nodes is the initial treatment.
For differentiated thyroid cancers, (papillary, follicular and hurthle cell carcinomas) adjuvant radioactive iodine (RAI) ablation/treatment should be considered depending on the histopathology report and post-op thyroglobulin values.
For medullary thyroid cancers, 2-3 months after surgery, basal calcitonin and CEA is monitored, and annual follow up is advised.
For anaplastic carcinoma of the thyroid, after surgery, adjuvant Radiation with IMRT or chemoradiation is preferred.
Treatment of patients with widespread or metastatic disease (Stage IV) depends on the type of cancer.
Differentiated thyroid cancers which are iodine sensitive, can be treated with radioactive iodine (RAI) ablation. Other options include targeted therapy with Lenvatinib (preferred) or Sorafenib, Selpercatinib for patients with RET fusion-positive tumors or immunotherapy with Pembrolizumab for patients with tumor mutational burden high (TMB-H). Local treatment options like SBRT or IMRT can also be considered for symptom relief.
For medullary thyroid cancers, targeted therapy options include Vandetanib, Cabozantinib or Selpercatinib (for patients with RET fusion-positive tumors). Immunotherapy with Pembrolizumab can be considered for patients with tumor mutational burden high (TMB-H).
Anaplastic thyroid cancers which are resectable are treated with surgery. Other options include targeted therapies like Dabrafenib/Trametinib (for BRAF V 600 mutated tumors), Selpercatinib (for patients with RET fusion-positive tumors) or Lenvatinib. Immunotherapy with Pembrolizumab can be considered for patients with tumor mutational burden high (TMB-H).
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